Eyebrow Transplant - A Cosmetic Surgery

Introduction:

Eyebrows play an important role in the face's overall appearance. This is because they are connected to three major facial muscles responsible for the expression - orbicularis oculi, corrugators, and occipitofrontalis. Eyebrows also serve a functional purpose by preventing sweat from dripping onto the eyes.

Eyebrow transplants have been performed since 1939, and it is a cosmetic procedure that involves transplanting hair follicles from one region of the body to the eyebrow area. The goal is to create a fuller and more defined eyebrow shape by promoting new hair growth in the transplanted area.

However, it is important to note that only some people with thinning eyebrows are good candidates for this surgery. Additionally, there are other options to consider before undergoing a transplant, such as low-dose oral Minoxidil, which can help to regrow hair in some cases.

What Are the Indications of Eyebrow Transplant?

Eyebrow restoration surgery, also known as eyebrow transplant, is a process that aims to restore the appearance of eyebrows that have been lost or damaged due to various reasons.

Some common indications for this type of surgery include:

• Thermal Burns - Burns caused by fire or heat can damage the hair follicles in the eyebrow area, leading to hair loss.

• Acid Burns - Similar to thermal burns, acid burns can also induce harm to the hair follicle and result in hair loss.

• Trauma - Injuries to the forehead or eyebrow can result in scarring and hair loss.

• Alopecia Areata - This autoimmune disorder can cause hair loss in various body parts, including the eyebrows.

• Frontal Fibrosing Alopecia - A type of hair loss that primarily affects postmenopausal women, resulting in hair loss in the eyebrow area.

• Trichotillomania - A disorder characterized by the compulsive pulling of one's hair, which can lead to hair loss in the eyebrow area.

• Scarring Alopecias - Certain skin conditions, such as lichen planopilaris, can cause scarring and hair loss in the eyebrow area.

• Hypothyroidism - A hormonal disorder that can result in hair loss in various body parts, including the eyebrows.

• Hansen's Disease - Also known as leprosy, this bacterial infection can cause hair loss in the eyebrow area.

In these cases, eyebrow transplantation is a way to restore the hair and shape of the eyebrow.

How Is the Case Selection Done for the Eye Transplant?

Eyebrow restoration surgery, particularly in post-burn or post-traumatic injury cases, should only be considered after all other functional issues and deformities have been corrected, and the scars have fully healed. Any further procedures, such as scar revision, flaps, skin grafts, or tissue expanders, can shift the position of the reconstructed eyebrow, resulting in an asymmetrical or tilted appearance. In the meantime, patients may need an eyebrow pencil to achieve a more natural look.

In cases of alopecia areata, frontal fibrosing alopecia, scarring alopecias, and trichotillomania, it is important to confirm that the underlying condition is not active before undergoing eyebrow restoration surgery. A biopsy or expert opinion may be required to ensure that the disease is not progressing and that the patient is a good candidate for the procedure. It is also important to note that the underlying condition may need to be treated in some cases before the eyebrow transplant can be performed.

What Are the Characteristics of a Natural Eyebrow?

The eyebrows are composed of several rows of hair that grow along the upper edge of the eye socket. The hair is typically short, thin, stiff, and slightly curved, tapering towards the end.

• Caucasian eyebrows are thicker than scalp hair, while Asian eyebrows are thinner.

• Men's eyebrows are usually 5 to 6 cm long and 1 to 1.5 cm wide, while women's eyebrows are 4.5 to 5 cm long.

• The eyebrow comprises three parts: the head, body, and tail. The head, which is the innermost part, makes up around 10-15 percent or 0.6 to 0.8 cm of the eyebrow and is situated below the upper edge of the eye socket.

• It usually has one or two rows of hair that are oriented vertically. The head typically has fewer, shorter, and lighter hair; some people may not want to reconstruct or highlight this part. The middle part, or body, makes up about 60 percent or 2.5 to 3 cm of the eyebrow and arches upward along the upper edge of the eye socket. The body is the most crucial part of the eyebrow for restoration.

• The best plan for a well-defined eyebrow is to use a criss-cross pattern that overlaps in the center along the longitudinal axis of the eyebrow. The tail, or the outermost part, makes up about 20 to 25 percent or 1.2 to 1.7 cm of the eyebrow. It is positioned above the upper edge of the eye socket and extends beyond the outer corner of the eye.

• The tail usually has less hair density than the other parts of the eyebrow, and hair loss in this area is more noticeable.

• Eyebrows can have different patterns depending on the layout and direction of the hair.

What Is the FUE Technique for Harvesting Grafts for Eyebrow Restoration?

• Follicular unit extraction (FUE) is a method of harvesting individual hair follicles from the scalp for transplantation. This method is preferred because it causes minimal damage to the surrounding tissue and results in minimal scarring, pain, and recovery time. A 0.8 mm punch, whether manual or motorized, is the most suitable for this procedure.

• Before the FUE procedure, a strip of hair is removed from the scalp, typically in the occipital or temporal-parietal area. This strip is typically 1.5 to 2 cm wide and 12 to 15 cm long, and the hair is trimmed to 3 to 5 mm. This is done to prepare the area for the FUE procedure and to ensure a natural and uniform aesthetic outcome.

• In cases with a shortage of single hair follicles, they may use alternative methods such as sub-follicular harvesting or selective split harvesting (removing one hair from a group of two to three). These methods aim to make the most of the available hair follicles to achieve the desired result.

Conclusion

Hair transplantation is an effective solution for those experiencing significant hair loss or defects in their eyebrows and eyelashes. The specific technique used will depend on the surgeon's expertise and the individual case, but it generally results in positive outcomes with minimal complications. In addition, proper follow-up care and education for the patient can ensure satisfaction with the results.